P5573 - Proton Pump Inhibitor Use and Risk of Clostridioides difficile Infection in Patients With Inflammatory Bowel Disease: A Propensity Score–Matched Cohort Study

Ali Osman, MD, MSCI Candidate¹, Madiha M. Mohammedi, ², Yezaz Ghouri, MD³
1Washington University School of Medicine in St. Louis, Ballwin, MO; 2Bradley University, Peoria, IL; 3SSM Health, Bridgeton, MO

Introduction: Proton pump inhibitors (PPIs) are commonly prescribed in patients with inflammatory bowel disease (IBD). However, their impact on the risk of Clostridioides difficile infection (CDI) remains unclear. We aimed to investigate whether PPI use increases the risk of CDI among patients with IBD.

Methods: Using the TriNetX Global Collaborative Network, we identified adult patients (≥16 years) with IBD (Crohn’s disease or ulcerative colitis). Two cohorts were defined: (1) IBD patients exposed to PPIs, and (2) IBD patients not exposed to PPIs or systemic corticosteroids (including prednisone). Patients with prior CDI were excluded. A 1:1 propensity score–matched analysis (n = 167,233 per group) was performed based on demographics and medication use. Outcomes included risk, time-to-event, and frequency of CDI over a 3-year follow-up.

Results: After matching, PPI use was associated with a significantly higher risk of CDI (6.0% vs. 2.4%; risk ratio: 2.475, 95% CI: 2.386–2.567; p < 0.001). Kaplan-Meier analysis confirmed reduced CDI-free survival in the PPI group (hazard ratio: 2.346, 95% CI: 2.260–2.435; p < 0.001). The mean number of CDI episodes was also higher among PPI users (mean: 1.72 vs. 1.26; p < 0.001).

Discussion: Among patients with IBD, PPI use is associated with a significantly increased risk of developing CDI. Clinicians should consider alternative acid suppression strategies and assess PPI necessity in this population.


Figure: able 1. Baseline Demographics and Medication Exposure in Patients With and Without PPI Use: Propensity Score–Matched Analysis

Disclosures:
Ali Osman indicated no relevant financial relationships.
Madiha Mohammedi indicated no relevant financial relationships.
Yezaz Ghouri: Capsovision – Consultant. Celltrion – Speakers Bureau.

Ali Osman, MD, MSCI Candidate¹, Madiha M. Mohammedi, ², Yezaz Ghouri, MD³. P5573 - Proton Pump Inhibitor Use and Risk of <i>Clostridioides difficile</I> Infection in Patients With Inflammatory Bowel Disease: A Propensity Score–Matched Cohort Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.